Education as a means of reducing medical expenses

The perception of the hidden curriculum on medical education: an exploratory study

BACKGROUND

Major curriculum reform of undergraduate medical education occurred during the past decades in the United Kingdom (UK); however, the effects of the hidden curriculum, which influence the choice of primary care as a career, have not been sufficiently recognized. While Japan, where traditionally few institutions systematically foster primary care physicians and very few have truly embraced family medicine as their guiding discipline, has also experienced meaningful curriculum reform, the effect of the hidden curriculum is not well known. The aim of this study is to identify themes pertaining to the students' perceptions of the hidden curriculum affecting undergraduate medical education in bedside learning in Japan.

METHODS

Semi-structured interviews with thematic content analysis were implemented. Undergraduate year-5 students from a Japanese medical school at a Japanese teaching hospital were recruited. Interview were planned to last between 30 to 60 minutes each, over an 8-month period in 2007. The interviewees' perceptions concerning the quality of teaching in their bedside learning and related experiences were collected and analysed thematically.

RESULTS

Twenty five medical students (18 males and 7 females, mean age 25 years old) consented to participate in the interviews, and seven main themes emerged: "the perception of education as having a low priority," "the prevalence of positive/negative role models," "the persistence of hierarchy and exclusivity," "the existence of gender issues," "an overburdened medical knowledge," "human relationships with colleagues and medical team members," and "first experience from the practical wards and their patients."

CONCLUSIONS

Both similarities and differences were found when comparing the results to those of previous studies in the UK. Some effects of the hidden curriculum in medical education likely exist in common between the UK and Japan, despite the differences in their demographic backgrounds, cultures and philosophies.

The current state of medical education in Japan: a system under reform

CONTEXT

Not since just after World War II has there been as dramatic a change in the system of medical education in Japan as in the last several years. Medical school curricula are including more education that mimics clinical practice through problem-based learning, organ-based curricula and implementation of the objective structured clinical examination (OSCE). In response to criticism and concerns, the Japanese government has also implemented 2 major changes in the system of postgraduate medical education. First, a 2-year structured internship has been required of all medical school graduates; the first cohort to undertake this completed it in April 2006. Second, an internship matching system was adopted and first implemented in 2003.

DISCUSSION

These reforms are leading to significant shifts in clinical education in Japan. Increasing numbers of medical graduates are entering residency programmes outside specialised university hospitals and core rotations place an increased emphasis on primary care.

CONCLUSIONS

These changes in the training of young doctors suggest that the general clinical competency of doctors in Japan will improve in the coming years.